Friday, May 25, 2012

HOW TO MANAGE PAIN

Posted by Dr Sarah Jarvis
It’s impossible to go through life without hurting some part of you
at some point. But the best treatments for pain will depend on the part
of your body affected, the side-effects they cause, other conditions you
might have and what you have taken in the past. Fortunately, these days
there are lots of options available – so there’s no need to suffer in
silence.

‘The pain ladder’

Paracetamol is an effective painkiller
for mild pain and can be added to other painkilling medicines to
increase their effectiveness. It is often used with drugs from the
‘opioid’ family, which includes codeine and morphine-based drugs.
To keep side-effects to a minimum, the World Health Organization has
devised a ‘pain ladder’. If pain is not controlled at one step of the
ladder, you move to the next step. The three steps are:

NSAIDs – you may not recognise the name, but you’ve probably taken them!

NSAID stands for ‘non-steroidal anti-inflammatory drug’. They include ibuprofen (brufen or nurofen), diclofenac (voltarol), naproxen and several others. NSAIDs reduce pain and inflammation. They are especially effective for:

They also help with the achiness and fever of bad colds and
‘flu-like’ illnesses. But beware – in the long term, NSAIDs can cause
quite a lot of side-effects (see below).

Nerve pain

The medical name for nerve pain is neuralgia. It can happen when a nerve is cut – such as after an amputation, after an infection affecting the nerve endings - such as shingles, in chronic conditions affecting the nerves - like diabetes, or if the nerve gets inflamed for no obvious reasons, as in conditions like trigeminal neuralgia
(which affects one side of your face). Nerve pain often doesn’t improve
with ‘normal’ painkillers. However, two groups of medicines can be
particularly effective for nerve pain:Amitriptyline - this drug is usually used to treat depression, but can work wonders in nerve pain.Anti-epilepsy drugs - two drugs in particular (gabapentin and pregabalin)
are often tried if amitriptyline isn’t effective. We know they work on
the nervous system (which is why they help with epilepsy) but they’re
being used more and more for nerve pain.

Risks and benefits

All tablets have side-effects. On the whole, the stronger the
medicine, the worse the possible side-effects (think of the side-effects
of cancer chemotherapy compared to paracetamol, for instance). Common
side-effects of different drug groups include:

Aspirin – inflammation of the stomach lining and stomach ulcers, possible bleeding from the stomach.

Paracetamol – very few side-effects in recommended doses, although very dangerous for the liver in overdose.

Opioid painkillers – constipation, confusion.

NSAIDs – inflammation of the stomach lining and stomach ulcers,
possible bleeding from the stomach; occasionally they bring on asthma,
kidney failure.